Abstract
IntroductionChilblains or perniosis is an acrally located cutaneous eruption that occurs with exposure to cold. Chilblains can be classified into primary and secondary forms. The primary or idiopathic form is not associated with an underlying disease and is clinically indistinguishable from the secondary form. The secondary form is associated with an underlying condition such as connective tissue disease, monoclonal gammopathy, cryoglobulinemia, or chronic myelomonocytic leukemia. Histopathology cannot accurately help distinguish the primary from secondary forms of chilblains. This article will raise the awareness of chilblains by presenting two unusual case reports of chilblains in men from Southern California with discussion of the appropriate evaluation and treatment of this condition.Case presentationsCase 1A 56-year-old Caucasian man presented in January to a Southern California primary care clinic with a report of tingling and burning in both feet, followed by bluish discoloration and swelling as well as blistering. He had no unusual cold exposure prior to the onset of his symptoms. He had a history of “white attacks” in his hands consistent with Raynaud’s phenomenon. His symptoms gradually resolved over a 3-week period.Case 2A 53-year-old Caucasian man also presented to a Southern California clinic in January with a 3-week history of painful tingling in his toes, and subsequent purplish-black discoloration of the toes in both feet. His symptoms occurred 1 week after a skiing trip. He had partial improvement with warming measures. His symptoms resolved 2 weeks after his initial presentation.ConclusionsChilblains is a relatively uncommon entity in warmer climates but can present during the winter months. Primary care providers in warmer climates such as Southern California in the USA may be unfamiliar with its presentation. It can be diagnosed clinically by the appearance of typical lesions during the cold damp season. Through a thorough history, physical examination and selected laboratory evaluation, underlying connective tissue disease or a mimic such as vasculitis or cutaneous leukemia can be excluded.
Highlights
Chilblains or perniosis is an acrally located cutaneous eruption that occurs with exposure to cold
Primary care providers in warmer climates such as Southern California in the USA may be unfamiliar with its presentation
Cribier et al studied biopsy specimens from patients with chilblains to determine if there are characteristic histopathologic features that distinguish primary chilblains from lupus erythematosus [1]. They concluded that it is not always possible to distinguish between idiopathic chilblains and lupus erythematosus based on histopathologic findings alone
Summary
We present two cases of chilblains seen in the winter months in Southern California. One case is purely idiopathic, whereas the other is more consistent with a secondary phenomenon related to the patient’s history of Raynaud’s and an underlying undifferentiated CTD. In both cases, lesions responded well to warming measures alone. Consent Written informed consent was obtained from the patients for publication of this case report and accompanying images. Authors' contributions RG was a major contributor in writing the manuscript, and made the diagnosis for Case 1. AA contributed to the manuscript and interpretation of patient data, and initially evaluated the patient for Case 1. AP made the diagnosis for the patient in Case 2 and contributed to the writing of the manuscript.
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